Credentialing Specialist

CloudRCM Solutions; Islamabad; On-site; PKR 300,000 - 700,000; Full time

Job summary

An established industry player in healthcare is seeking a detail-oriented credentialing specialist to manage provider applications efficiently. This role involves completing and tracking credentialing applications, maintaining accurate provider records, and ensuring timely communication with providers and payers. The ideal candidate will have at least 2 years of experience, strong leadership skills, and the ability to solve problems effectively. Join a dynamic team and contribute to the smooth operation of healthcare services while ensuring compliance and accuracy in provider credentialing.

Qualifications

• Minimum 2 years of experience in credentialing and provider enrollment.
• Strong leadership, communication, and research skills are essential.

Responsibilities

• Complete credentialing applications for providers and track their progress.
• Maintain accurate provider records and communicate with stakeholders.

Skills

Credentialing

Communication Skills

Research Skills

Problem-Solving

Leadership

Education

Bachelor's Degree

Tools

Credentialing Software

Job description

Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of providers for both Outpatient and ABA providers.

Track progress of outstanding applications and report progress to Client Managers/Team Leaders.

Monitor and update provider portals to ensure accurate information is visible.

Keep current provider records electronically in Credentialing software, electronic provider folders, and in provider hard copy folders.

Assist in obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc.

Prepare professional communication to providers, payers, and facilities.

Understand how provider credentialing impacts billing, contracts, and EDI.

Investigate solutions to problems and determine the best course of action.

Communicate clearly and professionally with team members, payers, and credentialing representatives.

Must be able to process the ERA & EFT application.

Must have brief knowledge of Govt., MCOs, and commercial Insurances enrollments.

Job Specification

EXPERIENCE REQUIRED:

Minimum 2 years of experience.

Leadership and management skills.

Good communication and research skills.

Joining: Immediate joining within a week.

Hospital & Health Care - Rawalpindi, Pakistan.